Official SealDepartment of Human Resources


#PBT-2924-099213
Supplemental Questionnaire

Last Name
First Name

 

2924 MEDICAL SOCIAL WORK SUPERVISOR (PBT-2924-099213)

The purpose of this Minimum Qualification Supplemental Questionnaire (MQSQ) is to obtain specific information regarding your education and experience in relation to the minimum qualifications for the recruitment, as stated on the announcement and will be used as a tool to screen applications for minimum qualification requirements. This Minimum Qualifications Supplemental Questionnaire (MQSQ) must be completed and submitted online with the application at the time of filing. Responses to items on the MQSQ must be supported by the information provided on the application in order to receive appropriate credit. Please be sure to include ALL relevant education and experience in the work history and education sections of the application. The information provided must be consistent with the information on your application and is subject to verification.

Applicants who do not possess the required Minimum Qualifications as stated on the job announcement will not be allowed to participate in the selection process.

Note: Falsifying one's education, training, or work experience or attempted deception on the application or MQSQ may result in disqualification for this and future job opportunities with the City and County of San Francisco. 

All information provided is subject to verification.  VERIFICATION MAY BE REQUESTED AT ANY TIME.


1.

Do you have a valid license as a Licensed Clinical Social Worker (LCSW) issued by the California Board of Behavioral Sciences as required under Title 22, California Administrative Code, Section 70055?

As a reminder, all qualifying license information must be listed in the application in order to be considered in review of Minimum Qualifications. If you do not include your LCSW license information on your application that you are about to describe in the "License and Certification" section of your application, you will not receive credit for this. If you are copying an old application, please take the time to update your Employment Record before submitting your application. 

Yes No
2.

How much verifiable POST-MASTERS DEGREE (MSW) experience as a Medical Social Worker in a health care setting do you possess? 

As a reminder, all qualifying experience must be listed in the application in order to be considered in review of Minimum Qualifications. If you do not include the work experience you are about to describe in the "Employment Record" section of your application, you will not receive credit for this experience. If you are copying an old application, please take the time to update your Employment Record before submitting your application

I do not have verifiable post-Masters Medical Social Worker experience in a health care setting
I have some experience, but less than 6 months of verifiable post-Masters Medical Social Worker experience in a health care setting
I have at least 6 months (1,000 hours) but less than 1 year (2,000 hours) verifiable post-Masters Medical Social Worker experience in a health care setting
I have at least 1 year (2,000 hours) but less than 2 years (4,000 hours) verifiable post-Masters Medical Social Worker experience in a health care setting
I have at least 2 years (4,000 hours) but less than 3 years (6,000 hours) of verifiable post-Masters Medical Social Worker experience in a health care setting
I have at least 3 years (6,000 hours) but less than 4 years (8,000 hours) of verifiable post-Masters Medical Social Worker experience in a health care setting
I have at least 4 years (8,000 hours) but less than 5 years (10,000 hours) of verifiable post-Masters Medical Social Worker experience in a health care setting
I have at least 5 years (10,000 hours) but less than 6 years (12,000 hours) of verifiable post-Masters Medical Social Worker experience in a health care setting
I have six years (12,000 hours) or more years of verifiable post-Masters Medical Social Worker experience in a health care setting
I have post-Masters Social Worker experience, but NOT as a MEDICAL Social Worker
3.

Does your post -Masters Medical Social Worker experience include supervising medical social workers in a medical social service program of a health care setting (such as a licensed hospital, licensed home health agency or licensed healthcare community and ambulatory center)?

As a reminder, all qualifying experience must be listed in the application in order to be considered in review of Minimum Qualifications. If you do not include the work experience you are about to describe in the "Employment Record" section of your application, you will not receive credit for this experience. If you are copying an old application, please take the time to update your Employment Record before submitting your application

Yes No
 

Based on your answer provided in #3, how much verifiable POST-MASTERS MEDICAL SOCIAL WORKER experience supervising Medical Social Workers in a medical social service program of a health care setting meeting the regulatory requirements of the State of California (such as a licensed hospital, licensed home health agency or licensed health care community and ambulatory center) do you possess?

I have less than 6 months supervising Medical Social Workers in a medical social service program of a health care setting meeting the regulatory requirements of the State of California (such as a licensed hospital, licensed home health agency or licensed health care community and ambulatory center)
I have at least 6 months but less than 1 year (2,000 hours) of verifiable experience supervising Medical Social Workers in a medical social service program of a health care setting meeting the regulatory requirements of the State of California (such as a licensed hospital, licensed home health agency or licensed health care community and ambulatory center)
I have at least 1 year (2,000 hours) but less than 2 years (4,000 hours) of verifiable experience supervising Medical Social Workers in a medical social service program of a health care setting meeting the regulatory requirements of the State of California (such as a licensed hospital, licensed home health agency or licensed health care community and ambulatory center)
I have at least 2 years (4,000 hours) but less than 3 years (6,000 hours) of verifiable experience supervising Medical Social Workers in a medical social service program of a health care setting meeting the regulatory requirements of the State of California (such as a licensed hospital, licensed home health agency or licensed health care community and ambulatory center)
I have at least 3 years (6,000 hours) but less than 4 years (8,000 hours) of verifiable experience supervising Medical Social Workers in a medical social service program of a health care setting meeting the regulatory requirements of the State of California (such as a licensed hospital, licensed home health agency or licensed health care community and ambulatory center)
I have 4 years (8,000) or more of verifiable experience supervising Medical Social Workers in a medical social service program of a health care setting meeting the regulatory requirements of the State of California (such as a licensed hospital, licensed home health agency or licensed health care community and ambulatory center)
4.

Based on the answer you provided above, in which health care setting do you have POST-MASTERS Medical Social Worker experience supervising medical social workers in a medical social service program? CHECK ALL THAT APPLY. 

As a reminder, all qualifying experience must be listed in the application in order to be considered in review of Minimum Qualifications. If you do not include the work experience you are about to describe in the "Employment Record" section of your application, you will not receive credit for this experience. If you are copying an old application, please take the time to update your Employment Record before submitting your application

Licensed Hospital
Licensed Home Health Agency
Licenced Healthcare Community and Ambulatory Center
I do not have experience in any of the above settings
 

CERTIFICATION:  By checking this box, I hereby certify that I am the author of the information supplied in this supplemental questionnaire. I understand that any false or incorrect statements may result in my disqualification or dismissal from employment with the San Francisco Department of Public Health and the City and County of San Francisco.  I also understand and agree that the information provided is subject to verification.